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I have been an active member in organized dentistry for many years. I recently moved my home and practice location to a different state. I then was refused a transfer of membership to my new state dental society because, three years ago, I refused to participate in a peer review procedure. Peer review participation was not required for membership in my previous constituent society, but it is here. How can they require this, and what are my options?
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Let’s first review the function of the peer review program. To do that, I will refer to information from several publications that any member may access via ADA.org.
The purpose of peer review is "to settle disputes between patients and dentists or third-party payers and dentists expeditiously, fairly and in a confidential manner."1 The type of disputes that may be addressed through peer review involve appropriateness of care, quality of care or whether a fee in question is the dentist’s usual fee for a procedure or is reasonable concerning the difficulty or complexity of the dental procedure used. Each constituent and component dental society has a peer review committee. The constituent peer review committee (through the appeal process) is the final recourse in settling the disputes.
Among its potential benefits, the peer review program serves the public and the profession by providing an alternate means of achieving resolution of disputes. It also may help both the dentist and patient avoid the high cost of litigation. Through this process, the dentist may preserve his or her good reputation and integrity in the community.
The following sections from the ADA Principles of Ethics and Code of Professional Conduct2 (ADA Code) form the ethical bases for the peer review process.
- – The introduction: "The dental profession holds a special position of trust within society. As a consequence ... the profession makes a commitment to society that its members will adhere to high ethical standards of conduct. Members of the ADA voluntarily agree to abide by the ADA Code as a condition of membership in the Association."
- – Section 3—Principle: Beneficence ("do good"): "The dentist has a duty to promote the patient’s welfare."
- – Section 3.B. Government of a Profession: "Every profession owes society the responsibility to regulate itself. Such regulation is achieved largely through the influence of the professional societies. All dentists, therefore, have the dual obligation of making themselves a part of a professional society and of observing its rules of ethics."
Because self-regulation is fundamental to the integrity of the profession, some state dental societies mandate that its members participate in the peer review process if he or she becomes the subject of a complaint. It is important to note that component and constituent societies are free to establish additional or more stringent codes of ethics, bylaws, rules and regulations, provided they do not conflict with or limit the ADA Constitution and Bylaws (ADA Bylaws)3 and the ADA Code. So it would not be considered unethical or contrary to the ADA Bylaws for a state to mandate participation in peer review.
In states that make peer review mandatory, the peer review committee may take several actions if a dentist refuses to participate. Its members may decide the case without the dentist’s input, they may refer the dentist to the society’s ethics or judicial committee for possible disciplinary action, or they may do both.4 Therefore it would behoove dentists to contact their state or local dental societies to find out if peer review participation is mandatory or voluntary.
Additionally, Chapter I, Section 30 of the ADA Bylaws gives the following definition of "in good standing":
A member of this Association whose dues and special assessments for the current year have been paid shall be in good standing; provided, however, that a member, to remain in good standing may be required under the bylaws of the member’s constituent or component society, to meet standards of continuing education, pay special assessments, [and] cooperate with peer review bodies or committees on ethics ... .3
With that being said, the issue then becomes whether it is permissible for a dental society that requires peer review participation to reject your application for transfer of membership based upon your choice not to participate in peer review while a member of a jurisdiction that does not require participation (and thus considers you to be "in good standing"). Just as importantly, you need to know what your options might be.
According to the ADA Bylaws, Chapter II, Section 40B, Removal From One Jurisdiction to Another, if your transfer of membership is denied, you may "appeal to the constituent society to which transfer is sought ... and thereafter to the Council on Ethics, Bylaws and Judicial Affairs (CEBJA) of this Association in accordance with the procedures in Chapter XII, Section 20C and D of the(se) Bylaws." The same holds true when an application for transfer of membership from one component society to another is denied (ADA Bylaws, Chapter III, Section 40). The ADA Council on Ethics, Bylaws and Judicial Affairs would be the final arbiter of this issue.
Of course, there always is the option of not joining a society that requires peer review participation. However, as you stated in your question, you have been active in organized dentistry for many years. Because of that, I am sure you recognize the importance of being part of organized dentistry’s voice in today’s society. So, weigh the advantages and disadvantages carefully, refer to the publications noted and then make your choice.
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